treatment should not be withheld if steroids are felt necessary to
improve reversal of shock.
- Assure that hypovolemia has been adequately treated by
checking a CVP. Children in sepsis may require significant
ventilatory settings and an increased intrathoracic pressure may
falsely elevate the CVP. Continuous monitoring for CVP trends
may help better ascertain the true volume status.
- Consider other causes for shock, including cardiogenic or
obstructive etiology. Pneumothorax and pericardial effusion are
generally ruled out early, both in the ATLS and PALS protocols.
However, continued fluid resuscitation and mechanical
ventilation may exacerbate cardiac function or cause
barotrauma resulting in late pneumothoraces.
- Recognize abdominal compartment syndrome (ACS), which
has received more attention in the pediatric population lately.
Healthcare providers have been shown to poorly recognize
ACS with physical exam alone. Continuous monitoring with
